Necrotizing Enterocolitis: A Narrative Review of Updated Therapeutic and Preventive Interventions

Context: Necrotizing enterocolitis (NEC) remains one of the most common causes of morbidity and mortality for premature infants in the neonatal intensive care unit (NICU). Many theories concerning its pathophysiology and inciting factors have been suggested but progression in preventing the onset of NEC has been minimal. While this article highlights the pathophysiology, management, and outcomes of NEC, it mainly serves as a narrative review to discuss the emerging methods of treatment and prevention.
Evidence Acquisition: A literature search was done using Medline/Pub Med, Cochrane Database of Systematic Reviews via Ovid, and CINAHL Complete with focus on articles published between 2000 and 2016. Searched terms included the following: necrotizing enterocolitis, pathogenesis, prevention, management, breast milk, formula, probiotics, prebiotics, and treatment.
Intestinal barrier dysfunction, hypoxic ischemic injury, receipt of packed red blood cells, immature intestinal immunity and alterations of the gut microbiome of the premature infant were reviewed factors that have been studied related to the pathophysiology of NEC. The presentation, staging and management remain relatively unchanged in the last few decades, though there have been a few studies evaluating different surgical options, various antibacterial regimen, and recently use of moderate hypothermia and amniotic fluid stem cells to treat NEC. Use of breast milk, use of pre-, pro- and postbiotics show promise in the prevention of NEC.
NEC is a likely multifactorial illness of the gastrointestinal tract affecting mostly premature infants. Recent studies have focused on preventative strategies, with promise in pre-, pro- and postbiotics; however continued research is imperative.